A Meta Analysis On Randomized Controlled Trials For Treatment Of Rheumatoid Arthritis With Tumor Necrosis Factor-alpha Inhibitors(Etanercept)

Background:Rheumatoid arthritis(RA)is one of the most common diseases in clinical practice,tumor necrosis factor-alpha(TNF-α)is one of the key proinflammatory factors in the pathogenesis of rheumatoid arthritis.In patients with RA,TNF-αconcentrations are elevated in the serum and synovial tissue.Blockage of the proinflammatory effects of TNF-αmay reduce the clinical signs and symptom of RA and improve quality of life.Many factory focus on tumor necrosis factor-alpha inhibitors,and it become the key drugs in the world.Objective:To evaluate the clinical efficacy and safety of tumor necrosis factor-alpha inhibitors(etanercept)in the treatment of active rheumatoid arthritis with Meta analysis.Methods:To retrieve the literatures on the randomized controlled trials of tumor necrosis factor-alpha inhibitors from the data bases including Medline,China National Knowledge Infrastructure and Wan Fang data base.Literature references were checked at the same time.Languages were restricted to Chinese and English. Trials were collected and evaluated according to the inclusion and exclusion criteria To evluate the qualified researches with the RevMan4.2 software.Meta-analysis was undertaken to explore the possible sourses of heterogeneity and relationship between the effect and the characteristics of the researches.Funnel plot were used to examine the publication bias.Results:There were 6 researches involving total 1199 cases accorded with the including standard.Both fixed-effects model and random-effects model were used to combine the results.Meta analysis showed:①The ORs for achieving ACR20, ACR50 and ACR70 responses in the etanercept group were higher when compared with the control group.②The ORs for achieving ACR20,ACR70 responses in the etanercept group was higher when compared with the MTX group.③There were no obvious difference between the etanercept group and the control group in patients withdrawal due to lack of efficacy(OR=0.46,95%CI=[0.18-1.20],p=0.11).④There were no obvious difference between the etanercept group and the control group in patients withdrawal due to side effects(OR=0.69,95%CI=[0.48-1.00],p=0.11).⑤Sensitivity analysis showed the results of this systematic review were not affected by quality.The funnel plots did not show evidence of publication bias.Conclusion:Meta analysis manifests that TNF-αinhibitors has significant curative efficacy in patients with rheumatoid arthritis.There was no significant difference between the etanercept group and the control group in adverse effects...